Management of the Sequelae of a Sport-Related Traumatic Dental Injury Using Ultrasound Examination in the Diagnosis and Follow-Up

About a quarter of all oral pathologies involving the oral cavity and dental apparatus are traumatic injuries, and a substantial number of these cases are the result of sports injuries affecting adolescents and young adults. Here, we report the case of a 25-year-old healthy female referred to the department of Endodontics for the evaluation and management of teeth 1.2 and 1.1 because of a chronic apical abscess in an area involved in a sport-related dental trauma in the past. A multi-modular diagnostic assessment, comprising conventional periapical radiographs, CBCT imaging, ultrasound, and histopathologic examination, led to a final diagnosis of an apical granulomatous lesion connected to both teeth, and an associated sinus tract. During the follow-up period of three years, the patient was reviewed twice a year and showed progressive healing of the bone and absence of the sinus tract. The present report shows the challenges of diagnosing complications arising from past dental trauma. Furthermore, it is the first documented traumatic case where ultrasound examination was fruitfully used. Emphasis should be put on introducing diagnostic ultrasound for the management of both apical periodontitis and the related sinus tract

Combined Management of Apical Root Fracture and Avulsion of Two Maxillary Permanent Central Incisors: A Case Report

As a result of a skiing accident, a ten-year-old girl suffered combined injuries to both maxillary central incisor teeth (#1.1 and #2.1). The injuries were uncomplicated crown fractures, apical horizontal root fractures, and a severe extrusive luxation of the coronal segments of the teeth. Her mother repositioned the teeth immediately, resulting in good initial healing. Nine months later, the patient was referred to a specialist to manage the endodontic consequences of the trauma. The apexification treatment of the fractured roots, using a preformed apical barrier technique with bioactive cement, was the treatment of choice, administered to both the avulsed roots at two separate recall visits. The best option for managing the fractured apical segments was to continue with the follow-up, which was conducted to assess the overall case at 30 months. The fractured apexes remained normally positioned inside the socket and were asymptomatic (as they presumably maintained a physiological vascular-nerve supply and, consequently, their vitality), while the apexification treatment led to the healing of the periodontal tissues and to hard tissue formation in the area of the interrupted roots in the avulsed portion of the teeth. The management of traumatic injuries in teeth often requires multiple treatment approaches, because these injuries rarely represent one single type of trauma

Enteropatia proliferativa da Lawsonia intracellularis nel suino

L\u2019enteropatia proliferativa del suino (proliferative enteropathy - PE), denominata anche ileite, \ue8 causata da Lawsonia intracellularis, un batterio intracellulare obbligato. La PE \ue8 una patologia a trasmissione oro-fecale che si manifesta soprattutto nella fase di magronaggio ed \ue8 responsabile di consistenti perdite economiche negli allevamenti intensivi. I danni economici sono causati dalla riduzione dell\u2019incremento ponderale e dell\u2019indice di conversione dell\u2019alimento e dall\u2019aumento della mortalit\ue0 e dei soggetti di scarto. La PE \ue8 endemica in numerosi Paesi con prevalenze di aziende ed animali infetti che, in Europa, superano il 90% e il 40%, rispettivamente. Nel suino, la patologia \ue8 caratterizzata da un ispessimento della mucosa intestinale dovuto alla proliferazione incontrollata delle cellule delle cripte intestinali accompagnata dall\u2019inibizione, ad opera di L. intracellularis, della maturazione e della differenziazione delle cellule caliciformi secretorie e delle cellule assorbenti. La conseguenza inevitabile \ue8 la riduzione dell\u2019assorbimento dei nutrienti e la perdita di aminoacidi e proteine nel lume intestinale, con conseguente diarrea. La PE si manifesta con due forme cliniche principali: 1) la forma acuta (enteropatia proliferativa emorragica - PHE) che si osserva principalmente in animali dai 4 ai 12 mesi d\u2019et\ue0, caratterizzata da una diarrea sanguinolenta e da elevata mortalit\ue0 (fino al 50%) e, 2) la forma cronica (adenomatosi intestinale - PIA) che colpisce suini dalle 6 alle 20 settimane d\u2019et\ue0, e il cui sintomo principale \ue8 rappresentato da una diarrea con feci pastose. Sono state descritte anche altre due forme cliniche a bassa incidenza: a) l\u2019enterite necrotica (NE), espressione di una forma di enteropatia proliferativa cronica complicata da infezioni secondarie che esita in un\u2019estesa necrosi coagulativa dell\u2019epitelio intestinale e, b) l\u2019ileite regionale (RI), risultante dalla guarigione delle lesioni dovute a NE e caratterizzata da deposizione di tessuto di granulazione e ispessimento della tonaca muscolare. La diagnosi indiretta, che viene generalmente eseguita utilizzando un test ELISA, consente di valutare l\u2019eventuale esposizione dei suini a L. intracellularis, mentre la diagnosi diretta (realizzata impiegando test biomolecolari qualitativi: PCR o quantitativi: qPCR, immunoistochimica - IHC) permette di valutare se l\u2019infezione \ue8 in atto. Analogamente a quanto accade per altre forme patologiche del suino, la semplice messa in evidenza di L. intracellularis nelle feci non rappresenta un criterio diagnostico valido nei confronti di PE. La corretta procedura diagnostica prevede la quantificazione del numero di microrganismi/grammo di feci e la messa in evidenza di L. intracellularis all\u2019interno delle lesioni intestinali. La profilassi e il controllo si basano sull\u2019applicazione di rigide misure di lavaggio e disinfezione che consentono di ridurre la contaminazione ambientale tra un ciclo produttivo e l\u2019altro e l\u2019applicazione di misure di biosicurezza interna. Particolare attenzione va riservata all\u2019alimentazione, che dovrebbe garantire l\u2019equilibrio della microflora intestinale tramite un corretto rapporto tra proteina altamente digeribile e frazione di fibra, con il supporto di integratori probiotici e prebiotici. In una logica di uso consapevole del farmaco, la somministrazione di massa di antibiotici durante la fase critica del magronaggio dovrebbe essere limitata ai soli gruppi con sintomatologia clinica, implementando invece la profilassi vaccinale.Porcine Proliferative Enteropathy (PE or ileitis) is an infectious enteric disease caused by the intracellular pathogen Lawsonia intracellularis (LI). PE is endemic in many countries and causes severe economic losses in swine production system worldwide due to reduction of daily weight gain, reduction of feed conversion ratio and increase of mortality and swine waste. In Europe, the prevalence of infected farms and infected animals is more than 90% and 40%, respectively. In PE, intestinal mucosa is thickened by uncontrolled proliferation of intestinal crypt cells while secretory cells and absorbent cells are decreased in number because LI prevents their maturation. Diarrhea is the consequence, due to reduced absorption and loss of amino acid and protein in intestinal lumen. Clinical forms are divided into acute (proliferative hemorrhagic enteropathy - PHE) and chronic form (porcine intestinal adenomatosis - PIA). Acute form affects animals from 4 to 12 weeks of age and is characterized by high mortality (>50%) and hemorrhagic diarrhea. Chronic form affects swine of 6-20 weeks of age and is characterized by pasty diarrhea. Based on morphological findings, two other forms are reported: necrotic enteritis (NE) and regional ileitis (RI). The first is a chronic form complicated by secondary infection that result in coagulative necrosis of intestinal epithelium. Healing of necrotic enteritis lesions results in both thickening of muscular layer of intestinal wall and granulation tissue deposition, both of which are typical findings of RI. Indirect diagnosis (e.g. ELISA) assess the exposure to L. intracellularis while direct diagnosis (PCR, qPCR, Immunohistochemistry -IHC) assess the current infection. Effective diagnosis is obtained comparing quantitation of microorganism/gram of feces with the detection of L. intracellularis within intestinal lesion. Prophylaxis and control of proliferative enteropathy are based on biosecurity measures combined with strict washing and disinfection measures to reduce environmental contamination. Proper nutrition management helps to ensure the balance of intestinal microflora by the use of highly digestible protein, by correct intake of fiber fraction and with probiotic and prebiotic supplements. To limit subclinical forms of disease, vaccination should replace antibiotic treatments which instead should be reserved only for symptomatic groups of pig

Clinical management of external cervical resorption: a systematic

This review investigated whether any therapeutic options influenced the outcome of treatment for teeth with external cervical resorption. Out of 870 articles identified by an electronic search, 60 clinical case reports and six case series were included. No randomised clinical trials were found. Risk of bias was assessed using Joanna Briggs Institute's tools. External surgical intervention was the preferred method of accessing the lesions. Removal of resorptive tissue was prevalently achieved mechanically. Bioactive endodontic cements were the preferred materials for restoring teeth. The outcome measures were based on clinical and radiographic parameters. Of the cases included in the review, no specific treatment approach had a superior outcome in relation to Heithersay's classification. Furthermore, due to the absence of randomised clinical trials, and to the low level of evidence associated with case reports/case series, it was not possible to define the optimum clinical treatment for external cervical resorption

The new bioactive hydraulic sealers in endodontics

[eng] INTRODUCTION: In the last twenty years, sealing cements based on tricalcium silicate cements have been introduced into the market for orthograde filling of the root canal system. These silicate-based sealing cements (CSBS) have demonstrated excellent results in humid environments, since they have great biocompatibility by inducing the formation of hard tissue when they come into contact with tissue fluids. The objective of this doctoral thesis is to investigate the potential advantages of these new materials through an ex vivo study and an in vivo study. HYPOTHESIS: Can CSBS affect the prognosis of endodontic retreatments? Can CSBS affect the prognosis of primary or secondary root canal treatments (RCTs)? OBJECTIVES: To evaluate the retreatment of filled teeth with a CSBS (study ex vivo) and evaluate the prognosis of RCT performed with a CSBS (in vivo study). METHODOLOGY: 1. In the ex vivo study, 36 mandibular premolars were instrumented and randomly distributed as follows: group BR and BR* = filled with CSBS and re-treated after one month and one year of storage, respectively; and group AH = filled with a resinous sealing cement (RBS) and re-treated after one month of storage. 2. The portrayed specimens were sectioned longitudinally and examined under the stereomicroscope (SM). The photomicrographs obtained were processed using Image J software to evaluate the amount of filling material remaining in the root canal and especially in the apical third. The ability to reach working length (WL), whether patency was achieved or not, and the time it took to complete retreatment were also analyzed. The ANOVA test and the Bonferroni post hoc test were applied (p < 0.05). 3. 2. In the in vivo study, 69 patients were randomly divided into two groups, according to the technique used: single cone (SC) technique in the BIO group and vertical gutta-percha condensation (WVC) technique in the PSC group. group. Likewise, two subgroups (BIOAP and PCSAP) contained cases of apical periodontitis (AP). 4. Four endodontic residents performed the cases under a standardized instrumentation and disinfection protocol. The results were analyzed using the periapical index (PAI) and clinical and radiographic results were evaluated at months one, three, six and twelve. Treatment success was evaluated according to periapical healing and dental survival. The test for equality of proportions, the t-test for equality of means and the non-parametric K-sample test for equality of medians were applied, as appropriate. MAIN RESULTS: 1. In the ex vivo study, permeability and reaching the working length of all teeth was achieved. The mean percentage of residual material was statistically significant between the BR and BR* groups (p-value = 0.048). Furthermore, the mean time to complete retreatment was significantly shorter for the AH group, followed by the BR group (p = 0.0001) and BR* (p = 0.0078). 2. In the in vivo study, the survival rate was similar for the BIO and PCS groups (p = 0.4074) and for the BIOAP and PCSAP (p = 0.9114). Likewise, the success rate was higher for the BIO groups, although without statistically significant differences (p = 0.0735). A progressive decrease in the PAI index was observed in both groups (BIOAP and PCSAP). CONCLUSIONS: 1. The evaluated CSBS sealing cement could be successfully removed from all root canals with simple anatomy. 2. The two techniques demonstrated clinical success after twelve months of evaluation and obtained a similar clinical and radiographic success rate.[spa] INTRODUCCIÓN: En los últimos veinte años los cementos selladores basados en cementos de silicato tricálcico han sido introducidos en el mercado para la obturación ortógrada del sistema de conductos radiculares. Estos cementos selladores basados en silicatos (CSBS) han demostrado excelentes resultados en ambientes húmedos, ya que tienen una gran biocompatibilidad al inducir la formación de tejido duro cuando entran en contacto con los fluidos tisulares. La presente tesis doctoral tiene por objetivo investigar las ventajas potenciales de estos nuevos materiales a través de un estudio ex vivo y de uno in vivo. HIPÓTESIS: ¿Pueden los CSBS afectar al pronóstico de los retratamientos endodónticos? ¿Pueden los CSBS afectar al pronóstico de los tratamientos de conductos radiculares (RCT) primarios o secundarios? OBJETIVOS: Evaluar el retratamiento de dientes obturados con un CSBS (estudio ex vivo) y evaluar el pronóstico del RCT realizado con un CSBS (estudio in vivo). METODOLOGÍA: 1. En el estudio ex vivo se instrumentaron 36 premolares mandibulares y se distribuyeron de forma aleatorizada de la siguiente manera: grupo BR y BR* = obturados con CSBS y retratados después de un mes y de un año de almacenaje, respectivamente; y grupo AH = obturado con un cemento sellador resinoso (RBS) y retratado después de un mes de almacenaje. Los especímenes retratados se seccionaron longitudinalmente y se examinaron bajo el estereomicroscopio (SM). Las microfotografías obtenidas se procesaron mediante el software Image J para evaluar la cantidad de material de obturación remanente en el conducto radicular y en especial en el tercio apical. También se analizó la capacidad para llegar a la longitud de trabajo (WL), si se consiguió permeabilidad o no y el tiempo que se tardó en completar el retratamiento. Se aplicó el test de ANOVA y el post hoc de Bonferroni (p < 0.05). 2. En el estudio in vivo 69 pacientes se dividieron de forma aleatorizada en dos grupos, según la técnica utilizada: técnica de cono único (SC) en el grupo BIO group y técnica de condensación vertical de la gutapercha (WVC) en el grupo PSC group. Asimismo, dos subgrupos (BIOAP y PCSAP) contenían los casos de periodontitis apical (AP). Cuatro residentes en endodoncia realizaron los casos bajo un protocolo de instrumentación y desinfección estandarizado. Se analizaron los resultados mediante el índice periapical (PAI) y se evaluaron los resultados clínicos y radiográficos en los meses uno, tres, seis y doce. El éxito del tratamiento fue evaluado de acuerdo con la curación periapical y la supervivencia dental. Se aplicaron, según el caso, el test de igualdad de proporciones, el t-test para la igualdad de medias y el test no paramétrico K-sample para la igualdad de medianas. RESULTADOS PRINCIPALES: 1. En el estudio ex vivo se consiguió permeabilidad y llegar a la longitud de trabajo de todos los dientes. El porcentaje medio de material residual fue estadísticamente significativo entre los grupos BR y BR* (p-valor = 0,048). Además, el tiempo medio para completar el retratamiento fue significativamente menor para el grupo AH, seguido del grupo BR (p = 0,0001) y el BR* (p = 0,0078). 2. En el estudio in vivo el índice de supervivencia fue similar para los grupos BIO y PCS (p = 0,4074) y para los BIOAP y PCSAP (p = 0,9114). Asimismo, el índice de éxito fue superior para los grupos BIO, aunque sin diferencias estadísticamente significativas (p = 0,0735). Una disminución progresiva en el índice PAI fue observada en los dos grupos (BIOAP y PCSAP). CONCLUSIONES: 1. El cemento sellador CSBS evaluado pudo ser removido con éxito de todos los conductos radiculares con anatomía sencilla. 2. Las dos técnicas demostraron éxito clínico a los doce meses de evaluación y obtuvieron un porcentaje de éxito clínico y radiográfico similar

The new bioactive hydraulic sealers in endodontics

Programa de Doctorat en Medicina i Recerca Translacional / Tesi realitzada conjuntament amb la Università degli Studi di Cagliari[eng] INTRODUCTION: In the last twenty years, sealing cements based on tricalcium silicate cements have been introduced into the market for orthograde filling of the root canal system. These silicate-based sealing cements (CSBS) have demonstrated excellent results in humid environments, since they have great biocompatibility by inducing the formation of hard tissue when they come into contact with tissue fluids. The objective of this doctoral thesis is to investigate the potential advantages of these new materials through an ex vivo study and an in vivo study. HYPOTHESIS: Can CSBS affect the prognosis of endodontic retreatments? Can CSBS affect the prognosis of primary or secondary root canal treatments (RCTs)? OBJECTIVES: To evaluate the retreatment of filled teeth with a CSBS (study ex vivo) and evaluate the prognosis of RCT performed with a CSBS (in vivo study). METHODOLOGY: 1. In the ex vivo study, 36 mandibular premolars were instrumented and randomly distributed as follows: group BR and BR* = filled with CSBS and re-treated after one month and one year of storage, respectively; and group AH = filled with a resinous sealing cement (RBS) and re-treated after one month of storage. 2. The portrayed specimens were sectioned longitudinally and examined under the stereomicroscope (SM). The photomicrographs obtained were processed using Image J software to evaluate the amount of filling material remaining in the root canal and especially in the apical third. The ability to reach working length (WL), whether patency was achieved or not, and the time it took to complete retreatment were also analyzed. The ANOVA test and the Bonferroni post hoc test were applied (p < 0.05). 3. 2. In the in vivo study, 69 patients were randomly divided into two groups, according to the technique used: single cone (SC) technique in the BIO group and vertical gutta-percha condensation (WVC) technique in the PSC group. group. Likewise, two subgroups (BIOAP and PCSAP) contained cases of apical periodontitis (AP). 4. Four endodontic residents performed the cases under a standardized instrumentation and disinfection protocol. The results were analyzed using the periapical index (PAI) and clinical and radiographic results were evaluated at months one, three, six and twelve. Treatment success was evaluated according to periapical healing and dental survival. The test for equality of proportions, the t-test for equality of means and the non-parametric K-sample test for equality of medians were applied, as appropriate. MAIN RESULTS: 1. In the ex vivo study, permeability and reaching the working length of all teeth was achieved. The mean percentage of residual material was statistically significant between the BR and BR* groups (p-value = 0.048). Furthermore, the mean time to complete retreatment was significantly shorter for the AH group, followed by the BR group (p = 0.0001) and BR* (p = 0.0078). 2. In the in vivo study, the survival rate was similar for the BIO and PCS groups (p = 0.4074) and for the BIOAP and PCSAP (p = 0.9114). Likewise, the success rate was higher for the BIO groups, although without statistically significant differences (p = 0.0735). A progressive decrease in the PAI index was observed in both groups (BIOAP and PCSAP). CONCLUSIONS: 1. The evaluated CSBS sealing cement could be successfully removed from all root canals with simple anatomy. 2. The two techniques demonstrated clinical success after twelve months of evaluation and obtained a similar clinical and radiographic success rate.[spa] INTRODUCCIÓN: En los últimos veinte años los cementos selladores basados en cementos de silicato tricálcico han sido introducidos en el mercado para la obturación ortógrada del sistema de conductos radiculares. Estos cementos selladores basados en silicatos (CSBS) han demostrado excelentes resultados en ambientes húmedos, ya que tienen una gran biocompatibilidad al inducir la formación de tejido duro cuando entran en contacto con los fluidos tisulares. La presente tesis doctoral tiene por objetivo investigar las ventajas potenciales de estos nuevos materiales a través de un estudio ex vivo y de uno in vivo. HIPÓTESIS: ¿Pueden los CSBS afectar al pronóstico de los retratamientos endodónticos? ¿Pueden los CSBS afectar al pronóstico de los tratamientos de conductos radiculares (RCT) primarios o secundarios? OBJETIVOS: Evaluar el retratamiento de dientes obturados con un CSBS (estudio ex vivo) y evaluar el pronóstico del RCT realizado con un CSBS (estudio in vivo). METODOLOGÍA: 1. En el estudio ex vivo se instrumentaron 36 premolares mandibulares y se distribuyeron de forma aleatorizada de la siguiente manera: grupo BR y BR* = obturados con CSBS y retratados después de un mes y de un año de almacenaje, respectivamente; y grupo AH = obturado con un cemento sellador resinoso (RBS) y retratado después de un mes de almacenaje. Los especímenes retratados se seccionaron longitudinalmente y se examinaron bajo el estereomicroscopio (SM). Las microfotografías obtenidas se procesaron mediante el software Image J para evaluar la cantidad de material de obturación remanente en el conducto radicular y en especial en el tercio apical. También se analizó la capacidad para llegar a la longitud de trabajo (WL), si se consiguió permeabilidad o no y el tiempo que se tardó en completar el retratamiento. Se aplicó el test de ANOVA y el post hoc de Bonferroni (p < 0.05). 2. En el estudio in vivo 69 pacientes se dividieron de forma aleatorizada en dos grupos, según la técnica utilizada: técnica de cono único (SC) en el grupo BIO group y técnica de condensación vertical de la gutapercha (WVC) en el grupo PSC group. Asimismo, dos subgrupos (BIOAP y PCSAP) contenían los casos de periodontitis apical (AP). Cuatro residentes en endodoncia realizaron los casos bajo un protocolo de instrumentación y desinfección estandarizado. Se analizaron los resultados mediante el índice periapical (PAI) y se evaluaron los resultados clínicos y radiográficos en los meses uno, tres, seis y doce. El éxito del tratamiento fue evaluado de acuerdo con la curación periapical y la supervivencia dental. Se aplicaron, según el caso, el test de igualdad de proporciones, el t-test para la igualdad de medias y el test no paramétrico K-sample para la igualdad de medianas. RESULTADOS PRINCIPALES: 1. En el estudio ex vivo se consiguió permeabilidad y llegar a la longitud de trabajo de todos los dientes. El porcentaje medio de material residual fue estadísticamente significativo entre los grupos BR y BR* (p-valor = 0,048). Además, el tiempo medio para completar el retratamiento fue significativamente menor para el grupo AH, seguido del grupo BR (p = 0,0001) y el BR* (p = 0,0078). 2. En el estudio in vivo el índice de supervivencia fue similar para los grupos BIO y PCS (p = 0,4074) y para los BIOAP y PCSAP (p = 0,9114). Asimismo, el índice de éxito fue superior para los grupos BIO, aunque sin diferencias estadísticamente significativas (p = 0,0735). Una disminución progresiva en el índice PAI fue observada en los dos grupos (BIOAP y PCSAP). CONCLUSIONES: 1. El cemento sellador CSBS evaluado pudo ser removido con éxito de todos los conductos radiculares con anatomía sencilla. 2. Las dos técnicas demostraron éxito clínico a los doce meses de evaluación y obtuvieron un porcentaje de éxito clínico y radiográfico similar

Conservative Non-Surgical Management of Horizontal Root-Fractured Maxillary Incisors in a Young Male with Angle Class II, Division 2, Malocclusion

Horizontal root fractures are a rare emergency in a dental office. The injury involves periodontal ligament, cementum, dentine and pulp. The healing is influenced by the location of the root fracture, the displacement of the fragments and the status of the pulp. This report presents a clinical case of horizontal fractures to both maxillary central incisors due to an act of violence. The type of occlusion has avoided a severe diastasis of the coronal parts with a subsequent damage to the pulp and periodontum. The fractures were treated with an orthodontic splint without any further therapy and hard tissue healing was observed. A careful diagnosis and well-timed treatment planning usually allow a cost-efficient and biologically-oriented therapy with a favorable outcome

Multimodular Assessment of a Traumatic Bone Cyst Overlapped with Apical Periodontitis

Traumatic bone cyst (TBC), a “pseudocyst” that usually affects long bones, is a rare lesion among cystic lesions in the jaws. The most commonly affected site is the posterior mandible. Most of the time, TBC is asymptomatic and discovered during routine radiographic examination. The treatment recommended for TBC is surgical exploration followed by curettage of the bony walls, which also serves as a diagnostic procedure. A 27-year-old Caucasian male with a noncontributory medical history was referred to our department for the endodontic evaluation of the mandibular right first and second molars, which were connected to an extensive asymptomatic osteolytic lesion. A multimodular diagnostic assessment involving CBCT imaging, ultrasound, and histopathologic examination led to a definite diagnosis of a TBC overlapping with apical periodontitis (AP). Subsequently, a multidisciplinary treatment approach was performed, including surgical excision and biopsy of the lesion, endodontic retreatment of the right mandibular first molar, and postsurgical root canal treatment of the second molar. During the follow-up period of five years, the patient was reassessed periodically once a year and showed, in the absence of signs and symptoms, progressive healing of the affected area. The present article reports a case following the CARE guidelines of a TBC combined with AP where a multimodular diagnostic assessment was performed and discusses the possible pathogenetic mechanisms involved in its generation